49 2021 - nicd.ac.za

1 TOLL-FREE NUMBER 0800 029 999 PAGE AFRICAWEEK 49 2 0 2 1 COVID-19 HOSPITAL SURVEILLANCE UPDATE As of 11 December 2021, 447,981 COVID-19 admissions and 94,962 in-hospital deaths were reported to DATCOV from 665 facilities (407 public-sector and 258 private-sector) in all nine provinces of South Africa. There has also been an increase in admissions in Gauteng since week 45, North West, Mpumalanga, Limpopo and Eastern Cape provinces since week 46, Free State, KwaZulu-Natal and Western Cape since week 47, and Northern Cape since week 48. There has been a small increase in deaths in all provinces except Northern cape and Western report summarises data of COVID-19 cases admitted to DATCOV hospital surveillance sites in all provinces. The report is based on data collected from 5 March 2020 to 11 December 49 2021 COVID-19 HOSPITAL SURVEILLANCE UPDATE TOLL-FREE NUMBER 0800 029 999 PAGE 1.

2 Number of hospitals reporting data on COVID-19 admissions by province and sector, South Africa, 5 March 2020-11 December 2021. TOLL-FREE NUMBER 0800 029 999 PAGE on hospitalisation was accessed f rom DATCOV, a hospital surveillance system for COVID-19 admissions, initiated on the 1 April 2020. A COVID-19 case was defined as a person with a positive reverse transcriptase polymerase chain reaction (RT-PCR) assay for SARS-CoV-2 or a person who had a positive SARS-CoV-2 antigen test who was admitted to hospital. Data on SARS-CoV-2 cases diagnosed in public and private laboratories submitted to the NICD were reported f rom the line list on the NMCSS. Case fatality ratio (CFR) was calculated for all closed cases, COVID-19 deaths divided by COVID-19 deaths plus COVID-19 discharges, excluding individuals who are still admitted in hospital.

3 For the calculation of cumulative incidence risks, StatsSA mid-year population estimates for 2020 were utilised. For comparisons of change in admission, we used 14-day daily average admissions in the current 14-day period compared to the previous 14-day was defined as patients receiving oxygen or invasive ventilation, treated in high care or intensive care wards, developing acute respiratory distress syndrome, or died. While oxygen, ventilation and ward of stay variables are updated daily for all admissions in the private sector, there may be delays with the data being updated in the public sector. Also, as patients remain in hospital their condition may change and percentage of severity may change over are submitted by public and private hospitals that have agreed to report COVID-19 admissions through DATCOV surveillance in all nine provinces of South Af rica.

4 On 15 July 2020, the National Health Council decided that all hospitals should report to DATCOV. As of 11 December 2021, a total of 665 facilities submitted data on hospitalised COVID-19 cases, 407 f rom public sector and 258 f rom private sector (Table 1). This reflects 100% coverage of all public and private hospitals that have had COVID-19 admissions. As new hospitals join the surveillance system, they have retrospectively captured all admissions recorded although there may be some backlogs in retrospective data capture. Name of province PublicPrivateEastern Cape8618 Free State3520 Gauteng4094 KwaZulu-Natal6947 Limpopo417 Mpumalanga319 North West1713 Northern Cape296 Western Cape5944 South Africa407258 WEEK 49 2021 COVID-19 HOSPITAL SURVEILLANCE UPDATE TOLL-FREE NUMBER 0800 029 999 PAGE TOLL-FREE NUMBER 0800 029 999 PAGE and geographic trends in admissionsFrom 5 March 2020 to 11 December 2021, a total of 447,981 COVID-19 admissions were reported f rom 665 facilities in all nine provinces of South Af rica.

5 South Af rica experienced three waves of the COVID-19 pandemic. There has been an increase in admissions in both sectors since week 45 of 2021 (Figure 1).Figure 1. Number of reported COVID-19 admissions by health sector and epidemiologic week of diagnosis, South Africa, 5 March 2020-11 December 2021, N=447, of COVID-19 admissionsEpidemiologic weekPu blicPr iva teWEEK 49 2021 COVID-19 HOSPITAL SURVEILLANCE UPDATE TOLL-FREE NUMBER 0800 029 999 PAGE TOLL-FREE NUMBER 0800 029 999 PAGE majority of admissions were recorded in four provinces, Gauteng 131,828 (29%), Western Cape 99,423 (22%), KwaZulu-Natal 71,417 (16%) and Eastern Cape 41,978 (9%) provinces. The weekly COVID-19 admissions have increased in all provinces in the fourth wave (Figures 2a and 2b).

6 Figure 2a. Number of reported COVID-19 admissions, by provinces with highest admissions and epidemiologic week of diagnosis, South Africa, 5 March 2020-11 December 2021, N=447,981 Figure 2b. Number of reported COVID-19 admissions, by provinces with lowest admissions and epidemiologic week of diagnosis, South Africa, 5 March 2020-11 December 2021, N=447, of COVID-19 admissionsEpidemiologic weekFree StateLimpopoM puma lang aNo r th Wes tNorthern Ca of COVID019 admissionsEpidemiologic weekEas te rn Ca peGaut en gKwa Zu lu-N atalWes te r n Ca peWEEK 49 2021 COVID-19 HOSPITAL SURVEILLANCE UPDATE TOLL-FREE NUMBER 0800 029 999 PAGE 3. Number of reported COVID-19 in-hospital deaths, by health sector and epidemiologic week, South Africa, 5 March 2020-11 December 2021, N=94, of COVID-19 deathsEpidemiologic weekPu blicPr iva te TOLL-FREE NUMBER 0800 029 999 PAGE AND GEOGRAPHIC TRENDS IN IN-HOSPITAL MORTALITYA total of 94,962 COVID-19 in-hospital deaths were reported in all nine provinces of South Af rica.

7 More deaths have been reported in the public sector in all three waves. There has been an increase in in-hospital COVID-19 deaths in both sectors since week 48 (Figure 3).WEEK 49 2021 COVID-19 HOSPITAL SURVEILLANCE UPDATE TOLL-FREE NUMBER 0800 029 999 PAGE 4a. Number of reported COVID-19 in-hospital deaths, by province with highest deaths and epidemiologic week of death, South Africa, 5 March 2020-11 December 2021, N=94,962 Figure 4b. Number of reported COVID-19 in-hospital deaths, by province with lowest deaths and epidemiologic week of death, South Africa, 5 March 2020-11 December 2021, N=94,962 Most deaths were reported in Gauteng 27,947 (29%), Western Cape 17,219 (18%), KwaZulu-Natal 15,786 (18%), and Eastern Cape 12,218 (13%).

8 There has been an increase in deaths in Gauteng and smaller increases in deaths in all provinces except Northern Cape and Western Cape. (Figures 4a and 4b). of COVID-19 deathsEpidemiologic weekFree StateLimpopoM puma lang aNo r th Wes tNorthern Ca pe020040060080010001200140016 of COVID-19 deathsEpidemiologic weekEas te rn Ca peGaut en gKwa Zu lu-N atalWes te r n Ca peWEEK 49 2021 COVID-19 HOSPITAL SURVEILLANCE UPDATE TOLL-FREE NUMBER 0800 029 999 PAGE 2. Number and cumulative incidence risk of COVID-19 hospitalisations and in-hospital deaths per 100,000 persons by province, South Africa, 5 March 2020-11 December Popula-tion mid 2020*Cumulative admissionsCumulative incidence risk of admissions / 100,000 Cumulative deathsCumulative incidence risk of deaths / 100,000 Eastern West410881629 Cape129278610 Cape700574199 Africa59622350447 *StatsSA mid-year population estimates 2020 TOLL-FREE NUMBER 0800 029 999 PAGE cumulative incidence risks of COVID-19 admissions and in-hospital deaths were highest in Western Cape, Free State and Gauteng provinces (Table 2).

9 WEEK 49 2021 COVID-19 HOSPITAL SURVEILLANCE UPDATE TOLL-FREE NUMBER 0800 029 999 PAGE TOLL-FREE NUMBER 0800 029 999 PAGE TRENDST here has been an increase in the average daily COVID-19 admissions comparing the previous 14 days and the current 14 days in all province, and an increase in the average daily COVID-19 deaths in all province except Northern Cape and Western Cape (Table 3).Table 3. Previous 14 days and current 14 days daily average COVID-19 admissions and deaths and percentage changes, South Africa, 13 November-11 December admissionsPercentage change in admissionsHospital deathsPercentage change in deathsPrevious 14 days average admissionsCurrent 14 days aver-age admis-sionsPrevious 14 days average deathsCurrent 14 days average deathsEastern * Reporting of new admissions in the most recent week may be delayedWEEK 49 2021 COVID-19 HOSPITAL SURVEILLANCE UPDATE TOLL-FREE NUMBER 0800 029 999 PAGE TOLL-FREE NUMBER 0800 029 999 PAGE 5.

10 Number of reported COVID-19 admissions by health sector and epidemiologic week of diagnosis, Gauteng, 5 March 2020-11 December 2021, N=131,828In all three waves there were higher numbers of admissions in the private sector. Weekly admissions at the peak of the second wave exceeded the weekly numbers of admissions at the peak of the first wave in both sectors. Weekly admissions at the peak of the third wave exceeded the weekly numbers of admissions at the peak of the second wave in both sectors (Figure 5). There has been an increase in admissions in both sectors since week 45. of COVID-19 admissionsEpidemiologic weekPu blicPr iva teGAUTENGWEEK 49 2021 COVID-19 HOSPITAL SURVEILLANCE UPDATE TOLL-FREE NUMBER 0800 029 999 PAGE has been an increase in admissions in City of Tshwane Metro since week 45, City of Johannesburg Metro, Ekurhuleni Metro, Sedibeng and West Rand since week 46 (Figure 6).